Vena Blanchard Interview

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Vena Blanchard has been a professional surrogate partner (and advocate
for ethical surrogate practice) for the last 20 years. She is the
current president of the International Professional Surrogates
Association (IPSA) and is also their senior trainer. She has written
and spoken extensively about sex therapy, surrogate partner therapy, and
the dynamics of sexuality and change.

SHS: For the sake of people who have never heard of it before, what
is surrogate partner therapy?

It's a form of therapy in which the therapist refers the client to work
with a surrogate partner. The client and surrogate build a
relationship, and in the context of that budding relationship they learn
about the clients strengths and difficulties in physical and emotional
intimacy. The clients develop emotional skills, and have a chance to
experience themselves and relationships in new ways. The surrogate and
the client share all that information with the client's therapist so
that the therapist can facilitate further growth and change. This is a
"triadic" form of therapy; it always involves three people: client,
therapist, and surrogate.

SHS: How long has surrogate partner therapy been around, and who
first developed it? Masters and Johnson?

Yes, we do count Masters and Johnson as our grandparents. The term
"surrogate partner" was first used by Masters and Johnson in 1970 when
they published Human Sexual Inadequacy. They were having a great
deal of success working with couples, and in order to be able to work
with single people who were experiencing sexual dysfunction they trained
and hired women to "substitute for" the wife of a client, in a program
that was identical (or very similar) to their couples treatment
program.

SHS: Had anyone even proposed it before 1970?

Not as far as we know. There are certainly people who suggest it has
precedents: specifically, in temple prostitutes or certain tribal
cultures where an experienced person trains or helps an inexperienced or
unwell person. But honestly I think those are leaps. There is no
precedent in a psychotherapeutic context with a triangular relationship
between client, therapist, and trained "helping other." There are
certainly similar models involving psychotherapist and physician
therapist, involving physician and physical therapist, or in education
when someone other than the instructor tutors a student.

SHS: How effective is surrogate partner therapy, in comparison to
"pure talk" therapies involving only the client and his or her
therapist?

There have unfortunately been no well-crafted research projects on this
subject. But what we do have is the anecdotal evidence of a
variety of therapists (who have no contact with each other) saying over
and over again, "This process seems to work for many clients, especially
ones who are socially inhibited or 'late-life-virgins.'" I'd say I have
a 98%-99% success rate with premature ejaculators, which I think is
probably going to be true across the board.

I think we all agree that surrogate partner therapy can be extremely
effective in working with naive and inhibited clients, as well as with
clients who have experienced physical or emotional trauma. Generally, I
think we can categorize the kinds of client concerns that are
appropriate and/or amenable to surrogate partner therapy as being those
in which the client is having difficulty with physical and/or emotional
intimacy, and needs the assistance of a caring partner to help them
resolve that difficulty. These difficulties could be the result of
self-consciousness, or of having developed some unfortunate patterns in
their history. They could be either social concerns or sexual
concerns.

SHS: What misconceptions do clients typically have about surrogate
therapy, if any?

Let's start with the common misconceptions that people have about
surrogate partner therapy, because by the time the client gets to the
surrogate partner hopefully his therapist has already answered a lot of
those questions.

One common misconception is that it is a mechanical or rote process; in
reality, it is most effective when it is developed specifically to
address the client's concerns, and the therapist, client, and surrogate
together are constantly re-evaluating what's the most useful and
appropriate. Another misconception is that it's all about sex, and
specifically all about intercourse; in reality, only the smallest part
of the process might involve explicit sexuality, and intercourse may
never be a part of the process - it's only included if it is clinically
appropriate and therapeutically in the client's best interest.

Yet another misconception is that it's about "having a good time."
Because it's therapy it tends to be rewarding and meaningful, but not
necessarily focused on short term pleasure; in fact, there are some
parts of the work for every client that are particularly
difficult and challenging, because they are struggling with
difficult/ancient material and developing new skills that initially feel
awkward and uncomfortable. They are also facing the part of their life
about which they often feel the most self critical and the most
ashamed.

A final misconception is that surrogates are all highly sexual and
always sexy (all you have to do is know us to know that's not always
true) and that this is somehow necessary or relevant (which it isn't,
not any more than it's necessary for your physician to be sexy). The
public seems to imagine that surrogates are wild women or men, when in
fact the vast majority of us are just regular-looking people with a lot
of compassion and an interest in helping others resolve their concerns
so they can move on to have healthy and happy lives.

SHS: What misconceptions do therapists sometimes have?

One is that the surrogate is a tool for them to use, when in fact the
surrogate is a para-professional, with a clinical judgment of her own,
and is a human being with feelings. Another is that the point of being
with a surrogate partner is for the client to have a one-shot learning
experience.

Occasionally, a therapist will imagine that the process can work
effectively without their own involvement, and that they can just refer
the client to the surrogate and then simply abandon the case. That
ultimately is not in the client's best interest; the client needs the
therapist as an advocate for their interest, as well as a person with
whom they can process their feelings. Often clients are not willing to
tell their friends and family that they are working with a surrogate
partner, and so their therapist is the only person outside of their
relationship with the surrogate who can help them have perspective and
process some of the emotional and therapeutic issues that arise in the
surrogate partner therapy.

Another misconception is that the surrogate needs to be the client's
ideal body type.

SHS: How should the therapist respond if a client begins to focus on
the surrogate's body type as being relevant, before even meeting him or
her?

I think that's a huge challenge in this culture, and the therapist may
need to work through his or her own issues about how primary visual
stimuli ought to be in the arousal process. I would hope the therapist
could help the client see that they have some learning to do: that the
surrogate partner is not their life partner and they can later choose
the partner of their choice, but that the surrogate partner has other
things to offer. The therapist could help the client develop a more
mature attitude about sensuality and sexuality, which moves beyond being
purely visual. I would hope that the therapist would look at this as
information about what's getting in their client's way: that the client
is essentially telling the therapist that this is part of their
problem.

Now obviously no one want to be intimate with someone who repulses them,
but if the client is focused on superficial aspects, then that's
information about how this client is stuck and where he needs
development. Hopefully the therapist recognizes that and has the skills
to facilitate client growth in this arena. I talked a great deal about
this when I presented at the World Pornography Conference in August of
1998 - about how difficult it is for some people to get beyond the
superficial and into something more profound and meaningful. For some
clients it is like a fetish; they are so narrowly fixated on one body
type, and on the visual, that they aren't able to appreciate
anything else about themselves or their partner other than the
visual. People like that are often not capable of having partners,
because nobody is ever perfect enough for them in real life. These
clients also tend to be very critical of themselves as well. This
doesn't mean they're beautiful people; quite often it's the exact
opposite, and it seems to be some sort of compensation.

I personally think of it as immaturity. This is not to say that you
can't love and appreciate the aesthetic beauty of someone without being
immature, but rather that having such a narrowly-defined sexuality
and/or relationship interest may be a sign of not having developed. By
the way, I don't mean "immature" in a perjorative sense, I just mean
that they're very young emotionally.

SHS: Are there particular types of talk therapy which you find
surrogate therapy meshes best with, or is it flexible enough to work
with most types of talk therapy?

It is extremely flexible. Any therapist who is comfortable with
change processes, and has a language they can use for talking about and
understanding meaningful change, can work with surrogate partners. I do
think there are some modalities that are fabulous: Humanistic,
Existential, and Object-relation therapies are very compatible.

Lots of sex therapists use the cognitive-behavioral therapeutic model.
Although there is a core philosophy within the surrogate partner therapy
process that is cognitive-behavioral, strictly behavioral
therapists tend to ignore a lot of the emotional content of the process;
clients, although they might resolve their sexual dysfunction in that
context, don't get the support they need for the complex emotions that
come up. Analysts in general tend to be disapproving, although when I
have worked with analysts they have been able to make very good use of
the material that came up in the client's work with me - even if they
didn't approve of the client working with me. I think it's useful for
them because they are used to processing counter-transference, and they
can make make good use of the counter-transference material that comes
up in the surrogate-client relationship.

SHS: Has the underlying philosophy of surrogate partner therapy
evolved since Masters and Johnson, and if so how?

I think it really has evolved. As our view of relationships and women
and sexuality has evolved, so has surrogate partner therapy; it's much
more focused on the relationship than it was in the early days. I went
back and reread Masters and Johnson's section on surrogate partners in
Human Sexual Inadequacy recently, and what they said about
their work with surrogate partners does not sound at all foreign or
unfamiliar; but my understanding is that what happened in practice was
much more behavioral, much less relationship-focused, and much less
about the evolving relationship. Masters and Johnson put couples and
surrogates and clients through a fairly rigid program, and each session
was mapped out even before the arrival of the client.

Today, clients and surrogates typically work in an open-ended process
rather than a rigidly-structured program, and the emotional content, the
level of client comfort, and the client's skills or difficulties at each
session are used to determine the most useful next step. It used to be
that surrogate partners worked only in clinics under the direct
supervision - though not necessarily "in the room" supervision - with
the therapist. Now most surrogates work in private practice with a
variety of therapists rather than just one therapist. It's also true
that in the beginning, surrogates were trained (if they were trained at
all) by therapists; surrogates these days are most commonly trained by
experienced surrogates in conjunction with experienced therapists.

And finally, as sex therapy has grown beyond a simple behavioral
orientation and more therapists with sophisticated training in
psychodynamics (and even psychoanalysts) have begun to do sex therapy,
they've brought in more sophisticated ideas about the surrogate-client
relationship; surrogates then carry those ideas into every other case
they work on. I think surrogates have become more sophisticated over the
years, having been trained by experienced surrogates who have lots of
years working with lots of therapists from lots of different therapeutic
orientations, and surrogates these days are much more likely to actively
engage in clinical decision-making with the therapist. It's less of a
hierarchical relationship than it used to be.

SHS: As the level of sophistication and training of surrogate
partners increases, can you imagine any scenarios in which (at least for
some types of simple dysfunction) the therapist could simply refer the
case to the surrogate and move on?

People have tried that in the past, and I think we all agree that it's
in the client's best interest for it to be a triadic relationship.
Because the surrogate and client get so close and do not have the
traditional therapeutic boundaries, and because there is the threat of
sexuality which stirs up such a large number of difficult emotional
issues for these particular clients, it is important that there be
someone outside of that dyad to help keep track of what is effective
with this client, what is working well, and where the client is stirred
up and potentially resistant. When we get very close to the most
difficult change issues for the client their resistance gets amplified,
and because the surrogate is so close it can be difficult for the
surrogate to keep track of exactly where they were in the process and
what it is that's stirring up the client; it's typical at the crux of
the therapy for the client to basically hunker down and refuse to
change, and it's the therapist's perspective outside of that
relationship which helps to keep the surrogate and client on-track.

Additionally, because we're working in such an intimate arena,
surrogates' personal issues can get stirred up; one of the therapist's
jobs is to help sort through how much of this is specific to this client
(in other words, how much of whatever issues are being stirred up for
the surrogate are the kinds of things that this client will stir up in
other people), and how much of this is just the surrogate's stuff which
he or she needs to deal with in their own personal therapy or in a
professional supervision group. So the therapist is an advocate and for
the clients as they engage some difficult learning and a professional
ally for the surrogate in a complicated and valuable clinical
process.

There are also a lot of clinical reasons why it's sometimes better for
the therapist to make certain suggestions, or for the therapist to
process certain issues, and try to keep those issues out of the
surrogate partner therapy (even though they have to be processed in
order for the client to make progress with the surrogate). As an
example, I have a client at present who has a lot of complicated things
going on with other women in his life, and he has always got some sort
of chaos and uproar going on in his dating life. He will talk about
those struggles as a way of avoiding being present, avoiding the
difficult work he needs to do with me. In fact that's what he does in
every other relationship in his life: he talks about his work struggles
when he on a date, and he talks about his personal problems when he's
supposed to be working. So its valuable for the therapist and I both to
be say to him, "You can talk about all those other relationship with the
therapist, but it's not useful for you to talk about them with Vena,
because it's your way of avoiding other more powerful work." He needs to
deal with these issues because they're related to his sexual and
relationship difficulties, which he came into therapy to address, and I
wouldn't be able to not deal with them if there weren't a
therapist involved.

SHS: Tell me a little bit about IPSA. What are its functions, and how
long has it been around?

IPSA was founded in 1973 (just three years after Masters and Johnson
first proposed the idea of surrogate partner therapy), by a group of
surrogates who created it as a support group for themselves. Within five
years it had expanded to become a professional body, with a code of
ethics, which was conducting trainings and setting some standards for
the developing profession. IPSA is the only functioning organization for
surrogates, and really has been the only functioning organization for
surrogates throughout its history. There have been some other people who
have tried to form groups, and were able to form support groups, but
never maintained any ongoing presence as a professional organization.
We're a California non-profit education corporation, and so we have a
bunch of goals that have to do with educating the public and the
therapeutic communities, and providing ongoing education for surrogate
partners (whether they're members of IPSA or not). Another one of our
goals is to stay abreast of relevant legislation and new information in
the field that relates to surrogate partner therapy and the treatment of
the kinds of concerns our clients have. It doesn't happen very often,
but occassionally we also have to review complaints from the public or
from therapeutic communities about either a therapist or a surrogate.

So, IPSA continues to mostly be about information referrals and
education, and because surrogate partners are not licensed or certified
by any other body, it is a focal point for discussions about what is
ethical and responsible practice for surrogate partners (as well as for
the therapists who work with surrogate partners and the people who want
to train surrogate partners). This involves being involved with other
organizations, like SSSS and AASECT, and having our own ethics
committee.

SHS: How long have you been the IPSA president?

For about the last three years. I've been a member of IPSA since about
1981, and have served on the board in some capacity or another almost
every year since then.

SHS: Is there anything in particular that you'd like to see IPSA
accomplish in the next ten years?
My big goal a couple years ago was to create a web site, which I just
completed. Other than that I think our goals remain primarily to train
surrogate partners, to train therapists to work with surrogates, and to
make sure that clients who need this kind of therapy can find it
somewhere in the world. More recently we've begun to have contact with
clinics and therapists who work with surrogates around the world, and
I'm hoping that we will once again be a functioning international body;
for the last number of years it's really just been limited to the United
States.

SHS: As people go through the surrogate training program that IPSA
offers, what sort of personal issues have come up for them that ended up
being "deal-breakers" as regards their continuing?

One of the issues that ends up being a deal-breaker for some folks is
that they realize they haven't worked through enough of their own issues
to really be available to someone who's learning. A number of people
realize that it's very difficult work, and that they don't really want
to make so much of their whole selves available to wounded other people;
it takes a great deal of maturity to be available to people who are so
uncomfortable with themselves.

We talked earlier about the clients who are fixated on appearances; it
also takes a lot of maturity to be able to work with someone who is
frequently saying, verbally or with their behavior, "I'm not sure I want
to trust you or be close to you," or "you aren't my type." One has to
remember that is the client's issue and to have compassion for them
about how they are limiting themselves, rather than to get personally
wounded and withdraw from that client. It's often the client's way of
manifesting their resistance that a great deal of patience. One of the
skills that's required of a surrogate partner is an intellectual
capacity to hold a lot of clinical and philosophical information and
still be present and available for emotional contact - to be both the
partner and the clinician at the same time, to not let one's clinical
task turn one into a distant observer with a clipboard, and to not let
one's personal feelings so overwhelm the moment that one loses clinical
perspective and makes poor choices on the client's behalf. It's not
uncommon for people to realize that it's just a lot more complicated
than they thought, and that simply having compassion and liking sex
isn't enough.

SHS: So, what personal characteristics would you identify as the most
important for a surrogate partner to have?

I'd say compassion, intelligence, a sex-positive attitude, and being
non-judgmental about consensual lifestyles and sexual orientations. You
have to be brave enough to be non-conventional because there is so much
question, even within the therapeutic communities, about the legitimacy
of this work. One has to be comfortable being a pioneer, and sometimes
going without societal approval.

SHS: How could someone know that they might benefit from surrogate
therapy? In other words, as they're thinking about their problems or
working with a traditional "talk" therapist, what would ideally be the
triggers for them to begin looking into surrogate partner
therapy?

That's a good question. Basically, they might consider looking into
surrogate partner therapy if their concerns have to do with physical
and/or emotional intimacy, and especially if they additionally
find they are not able or willing to get into a relationship in which
they could work on these issues. I actually think that's the primary
one: that they are not letting themselves be in a relationship because
of their problems, yet they need a relationship to resolve it. Of
course, some people don't want relationships, and that's OK; it's when
they want to be in a relationship but aren't willing or able to
do so, that working with a surrogate can be really useful. The IPSA
brochure "Surrogate Partner Therapy" says it pretty well... Let me just
quote from it for a moment:

The concerns that motivate clients to seek surrogate partner therapy
often range from general social anxieties to specific sexual
dysfunctions. Some common sexual concerns for male clients involve
dissatisfaction with orgasm, ejaculation, and/or erection difficulties.
Female clients' sexual issues might involve difficulties with orgasmic
release or with penetration. Clients of either gender may seek therapy
to address problems relating to lack of experience; fear of intimacy;
shame or anxiety regarding sex; low-level of arousal; lack of sexual
desire.

Concerns for either gender might result from one of the following:
medical conditions, negative body image or physical disfigurement;
physical disabilities; issues of sexual, physical, or emotional abuse
and/or trauma (rape or incest, for instance); confusion about sexual
orientation; lack of sexual or social self-confidence.

SHS: In general, what's the easiest way for a potential client to
locate a therapist who works with surrogates? Should they contact
IPSA?

If they're in California, they should contact IPSA. If they're not in
California but are in the United States, it's probably best for
them to contact AASECT and ask for a list of sex therapists in their
area, and then to ask those sex therapists whether they work with
surrogates or if they know others who do. There are surrogates in only a
few places in the world. For most people this means they will have to
travel some distance to work with surrogates.

SHS: New York or California, basically?

California. The problem in New York is that prostitutes also advertise
themselves as sex surrogates, and so it can be very difficult to
determine who is a legitimate surrogate and who is not.

SHS: What prevents that from happening in California? Is it just not
part of the culture?

That's correct, it's just not part of the culture. However, there
are some people in California who call themselves surrogates and
work independently of therapists; often it turns out they really haven't
been trained. If the client is in California or is able to come to
California, contacting IPSA is definitely the best way.

SHS: Is there anything else you'd like to say about IPSA before we
move on?

Let me give just a tiny bit of information that isn't on the IPSA web
site. There are three categories of membership in IPSA. We have full
members, who are working surrogate partners who have agreed to honor
this IPSA code of ethics; we have associate members, who are mostly
retired surrogates, but who might also be surrogate partners that for
some reason are not willing to make the commitment to honor the IPSA
code of ethics; the other category of membership is for therapists who
work with surrogate partners.

SHS: What aspects of your job do you find the most satisfying, and
which the most frustrating?

I find the clients, and the generosity of therapists (their willingness
to share information and expertise about and with me and with their
clients), to be very satisfying. I also love training surrogates. For
me, the most frustrating parts are having to continually explain what
surrogate partner therapy is not, and (even in the sex therapy
field) having to justify it.

SHS: How would you like to see the surrogate partner profession grow
or change in the next ten years?

I would like to see more people train as surrogate partners, and I would
like to see more therapists trained to work with surrogates. I think
that as more therapists really understand what the work is and educate
their clients about it, that more of their clients will be able to
access this treatment modality. I would also like to see a lot more
people join IPSA and do the organizational work, so I don't have
to do it all!

SHS: I can certainly relate to that sentiment... Ms. Blanchard,
you're in an excellent position to observe our culture's impact on
sexuality; I'm curious if any themes have come up in your work with your
clients, common misconceptions about sexuality or particular
dysfunctions?

Absolutely. Common myths are that a proficient sexual partner knows it
all without talking or asking, that superficialities (whether it's the
appearance of partners or oneself) are all-important, and that technique
is more important than contact and communication. Additionally, my
understanding is that men lie to each other about sex, perpetuating
myths about male sexuality, and that it's very difficult for men to get
a sense of their acceptability as sex partners.

One thing that's very difficult for many of my male clients is the
societally-imposed responsibility to take the lead in initiating
relationships and sexuality; there's a great deal of distress they feel
because they're afraid that their interest will be either misperceived
as sexual harassment, or because they feel like the entire
responsibility is on them. For lots of my clients their validity and
acceptability as people seems, in their minds, to be tied to their
proficiency at sexuality, and because they feel uncomfortable (and that
is not part of the culture's ideas about men) they feel like they aren't
proper men. If our culture were to shift a little and acknowledge that
men, like other human beings, can be scared and still be men, or can be
shy and still be men, then they wouldn't doubt themselves as thoroughly
and wouldn't have to hide the information that they're nervous or scared
or inexperienced. They end up having to work with me when they're
ashamed of their lack of experience or their lack of comfort - not
because they actually need some unique skills that I offer, but because
they need the safety of knowing that they won't be treated badly.

I have heard from a lot of men recently that they feel increased
pressure from younger women to perform for them without feelings, and
they find more mature women more accepting and more tolerant. So I do
have a little concern about what's coming in the future. I don't think
that younger women have always been intolerant, I wonder if it's
something about the current culture of young adults. If you watch
"Loveline" - Dr. Drew and Adam - Adam's brusque orientation and lack of
compassion may be a reflection of an attitude particular to that
generation. Or anyway, that's what my clients are reporting...

In general, what I have discovered for myself and my clients is that
trust, comfort, and loving are the best foundation for healthy and happy
sexuality. It takes a lot of reprogramming for people to pay attention
to that rather than to all the superficial things which ultimately don't
lead to happiness or sexual health.

SHS: What percentage of your clients are late-life male
virgins?

About 50%

SHS: This would seem to put you in a good position to answer a
question I've had for quite a while. I'm curious about the extent to
which, in the absence of better information, people actually believe the
misconceptions about sexuality that are portrayed in mainstream video
pornography.

To start with, virgins are not the only ones who have those
misconceptions; my experience is that even people who have had
real-life sexual experiences with another person still imagine that
they're inadequate because they don't perform like the guys in porn. I
would say, and this was part of my WPC presentation back in August, that
this is the most common effect of pornography: the generation of
misconception. One misconception is the belief that you're supposed to
thrust constantly, and the other is that you're supposed to like every
single activity - the raunchier the better. It's not that these people
think they like those things, it's that they keep trying to do them and
they don't know why it's not satisfying.

But the fact is that not everyone believes these misconceptions, and one
of the things I was trying to decipher was why some people believe them
and others don't. I think the primary difference is in how much they've
matured as individuals and learned to trust themselves about
anything. If they trust their own feelings about other things,
then they often trust their feelings to be good guides in sex. I think
this is one of the reasons that some fundamentalist religions tend to
breed more sexual dysfunction: because the locus of control and knowing
is outside one's self, individuals who don't trust their own feelings
will get porn and think that's the measure of reality. But almost all my
clients believe porn to some extent, whether it's about cock
size, or about what really turned on women look like, or about what the
sounds of sex are. Certainly it's true that the less experience one
has, the more one is looking outside one's self for information about
what is normal. But even people with experience still rely on it
to a certain extent; most of us don't get the chance to watch other
people be sexual, and pornography is one way that people try to get a
sense of what is normal, or who they are, or where they fit on the
continuum of sexual activity.

SHS: Do you often find yourself having to do basic sex education? Do
today's clients tend to think that women typically reach orgasm just
through intercourse, do they not know where or what the clitoris is,
etc.?

Whether clients have watched a lot of pornography or not, sex education
is a normal part of my work with most of them. Some people only need a
little bit, and some people need more. I have a library that I loan to
clients for additional information.

SHS: Just out of curiosity, what books do you tend to
recommend?

I recommend Bernie Zilbergild's
The New Male Sexuality,and Marty Klein's
Ask Me Anything. Those two books I recommend right off the bat,
even before they begin therapy. I also recommend Adele Kennedy's book
Touching
for Pleasure; this book now seems to be out of print, but I do
know some people who have stockpiled it because it's so fabulous.
If I work with a woman, I might recommend Lonnie Barbach's
For Yourself (though if I'm working with a male client who has
ejaculatory inhibition I might recommend this book too) and possibly
Joann Loulan's book
Lesbian Sexuality.

SHS: Do you ever encounter clients who have had their only
sexual experiences with sex workers, and if so what issues tend to come
up for them as a result?

Many of these clients have been wounded or shamed, although occasionally
it was a positive experience for them.

SHS: For those who experienced this wounding or shame, what was the
source of it?

There are two sources, really. One source is when the experience was
something initiated by somebody else - their father, their brother,
their friends, or their army buddies - and they were expected to perform
sexually in some non-private situation (or when it wasn't really of
their own choosing) but they were too embarrassed to say, "I don't want
to do this." The other source is a callous attitude on the part of the
sex worker which manifested as either verbal criticism, or an attitude
of disdain or impatience.

SHS: But there have been clients for whom it was a positive
experience...

Yes. It depends on the interaction and the person and culture from which
the client came. Where prostitutes are not treated so badly by their
culture, they don't tend to treat their clients as badly.

SHS: When you work with therapists, is the client typically given a
formal diagnosis before the therapy commences?

That depends on the therapist and it depends on whether or not there's
insurance, because they're required to do that for insurance purposes.
Typically the therapist has worked with the client for anywhere from
several sessions to several years, and has a pretty good sense of the
client's mental health, but often does not understand exactly
what is going wrong for the client in the sexual or relationship
arena.

SHS: This actually leads me to my next question... I'm curious about
whether you would encourage someone to enter surrogate partner therapy
who DOESN'T have any specific dysfunction, and may actually have a
healthy and happy sex life, but who just wants to learn more or have an
opportunity for personal growth.

Not really; I think there are workshops and other places for people to
get that instead. I actually think that's a really valuable question to
ask, even though the answer is mostly "no," because so many people
wonder if they couldn't just learn to be better lovers with surrogates.
It's true that they could learn to be better lovers with surrogates, but
they could also just take classes from the Human Awareness Institute or
take a seminar on Tantra...

SHS: Which might be less expensive and more efficient...

Yes, and then they also get a chance to meet people and partners who are
learning the same things. Surrogacy would be much more expensive, and is
really designed for people who have bigger issues. Additionally, people
who are looking for enhancement are also looking for fun, and surrogacy
work isn't exactly about that...

SHS: What are your thoughts on people who have surrogacy training but
who aren't working in a surrogate partner context (i.e. they're calling
themselves, say, "Intimacy Coaches," and working with individuals and
couples without a therapist)? I agree with you about the workshops, but
if people still want one-on-one work and their concerns aren't so
emotionally intense to where a therapist is necessary, then the skills
that surrogates possess would seem to be ideal.

This has definitely been done. Former surrogates have conducted couples
workshops, and there's one surrogate who runs workshops for people
interested in learning what we know who don't necessarily need to do it
in the context of therapy.

IPSA allows people to take the training who aren't specifically
interested in becoming surrogate partners; sometimes they want to learn
more just for themselves, and it becomes a source of profound personal
growth for them. In that sense what surrogates have to teach
they can certainly teach outside the context of therapy.

But this question does bring us into a complicated arena of politics...
Technically, the term "surrogate partner," by definition, applies
only to a triadic relationship involving client, surrogate, and
therapist. We might say that surrogate partners have skills that can be
used in other arenas, like sexuality education or in some sort of
coaching capacity, but if I were not personally receiving the referral
from a therapist and it looked like we would be doing traditional
surrogate partner therapy, the client would still have to find a
therapist to work with. There are some circumstances in which some
surrogates offer themselves to work with certain kinds of clients
without a therapist involved, and hopefully they're calling it something
other than surrogate partner therapy.

SHS: I'm curious if any of the distinction between surrogate and sex
worker, at least in California, hinges on the fact that the surrogate's
relationship to the client is triadic? In other words, if no therapist
were involved, would you be in more danger of falling under the
prostitution laws?

It depends. In the state of California, prostitution laws are written
with a focus on the intention of exchanging sex for money; if I'm
working dyadically they could question whether or not my intent is
therapeutic, but anyone who has actually worked with me or observed my
work would know that it is.

SHS: I was intrigued by a comment in one of the IPSA brochures, which
mentioned that some (presumably heterosexual) clients might be better
served by a same-sex surrogate who is acting as a sort of "role model"
rather than as a surrogate per se. When is this most
appropriate?

Sometimes, people who have been molested or who have profound body-image
issues need a safe environment in which to do their initial exploration:
to learn to relax, in the context of another person, but not necessarily
in a context in which they feel the greatest sexual threat. For some
heterosexual clients, a same-sex partner might feel safer. I've worked
with a couple of heterosexual women who were married, where it was
basically for sexuality education. It wasn't that I showed them how to
masturbate, but we talked about masturbation, we talked about some of
the complexities of heterosexual relationship, and I taught them the
concept of sensate focus: doing non-sexual touching. Once they owned
that for themselves they could take that information back to their
relationship and explore and touch for their own pleasure, rather than
simply doing what their husband wants them to do it.

SHS: I'm curious, in this context, what works well for people who
have body image issues.

Unfortunately, due to homophobia many people aren't more
comfortable in the presence of a same-sex person, but let's say for an
obese woman who is working on feeling OK with herself and her body,
working with a heterosexual female surrogate partner might help her
allow herself to be touched on the hands, the face, and the feet. She
might even disrobe. It would be about getting comfortable with herself
and getting honest feedback from her partner about what it feels like to
have a hug or sit close. People with weight issues sometimes have
body-odor concerns or logistical concerns about how to negotiate their
bodies with partners.

Transsexuals (male-to-female) have also successfully worked short-term
with heterosexual female surrogates, to discuss the female body and
female sexuality. In this case it's more of a sexuality education
process.

SHS: There's been a lot of dialog recently, among sex workers and in
the writings of people like Dr. Carol Queen, about the archetype of
"Sacred Whore" or "Temple Prostitute." I'm curious what you think about
this whole idea.

I haven't examined the anthropological basis for the dialog. At the very
least, it's a useful Jungian archetype.

SHS: I'm interested in your opinion on this subject because, even
though the "Sacred Whore"'s relationship to the "Customer" is not
triadic, the intent does have to do with sexual healing and
growth. Given your perspective, I'm curious if you've thought of any
ways (for example) that they could introduce some sort of triadic
element, and whether this would even make sense for them to do?

As far as I know, within that model there IS no triad, and the power
rests entirely with the woman. That's the appeal of the archetype: that
there's this all-knowing, all-nurturing sexual Goddess or her
representative. I suppose if a person is sufficiently flexible in the
way they conceptualize it, however, then the team of therapist
and surrogate, together, could be seen as the one nurturing, healing,
representation of the Goddess...

Some of the concerns I have about the Sacred Whore model have to do with
the power residing in the healer rather than in the healed. From my
point of view, what makes the healing more permanent and lifelong for my
clients is not that I was loving with them once, but that
they learned how to be loving with themselves and with others. My
focus is almost entirely on how they can mature and develop, so they can
have relationships in the future with people other than me.

Perhaps other people are more magical than I am, and can heal in that
one-time, one-shot, single experience, but frankly I need a few months
and a lot of thinking (as well as some interpersonal magic) to be able
to really help my clients. Again, this is because my goal is not just
for them to feel a moment of magic, but rather for them to learn how to
create that feeling for the rest of their lives. It's the old "feed
'em, or teach 'em how to fish" saying...

SHS: Can you think of any way in which the structure of this
relationship could be changed so that more power would rest with the
healed?

Many people are working on that, and there's a book coming out shortly:
Linda Savage has a book coming out this spring on female sexuality that
interlinks modern sex therapy and the ancient archetypes. And, within
the students of the Quodoushka tradition there are some people who are
doing similar work; although they like the archetype of the sexual
healer, they have broadened it to include a responsibility to the
long-term well-being of the client, and not just to the short-term
experience. For instance, rather than healing the client with a one-time
experience they are constructing learning experiences for the client
over a series of sessions, which should help the client to develop new
skills; they do that from the point-of-view that as a sexual healer they
should help the client develop more of themselves. I don't know too many
people doing that, to tell you the truth, but this may just be the
limitation of my circle of friends....

SHS: So these folks, in some cases coming from traditional sex work
backgrounds, have managed to latch onto what they find to be a very
powerful and empowering archetype. Is there any similarly empowering
archetype for the triadic client/therapist/surrogate relationship, or
any precedent for such a thing in history?

Good question. I haven't heard anybody talk about this sort of thing
with a focus on the triadic relationship. There are some
surrogates who are very attached to this Sacred Sexual Healer archetype,
and they see it as having a relationship to the work that they do. But
strangely enough, I think parenting comes the closest, where two people
have a third person's interests at heart and the three of them work
together to develop that third person, with the idea that this third
person will grow, mature, and eventually leave them. That's certainly
one model, and it's not uncommon, to tell you the truth, for clients to
say that they are aware of this dynamic and feel a little bit like the
therapist is a parent and they are growing up through therapy.

But honestly I think of it more as a healing community, because
therapists and surrogates tend to rely on a whole body of knowledge: the
books I bring in, the videotapes the therapist might show, the therapist
and surrogate and client together as a team.

SHS: Which I imagine is psychologically comforting in and of
itself.

Yes, because now the client has a whole community that supports them. We
eventually refer clients to workshops and dating groups and such, which
lends even more of a sense of having entered an accepting healing,
community.

Diagnosis/Assessment

Effective surrogate partner therapy illuminates the client's physical
and emotional patterns, skills and difficulties, as well as highlighting
developmental issues, and defensive and characterological structures.
We use the emerging transference, projective identification,
counter-transference, experiences of anxiety, intimacy, arousal, anger,
success, failure, etc. to inform client, therapist and surrogate about
the roots and branches of the client's problems and means of learning,
and about his history and his unfolding new self. For this aspect of the
work to be effective, surrogate and therapist need to maintain
consistent, high quality, and professional communication.

Skill Building

Simultaneous structured and non-structured experiential processes
provides opportunities for clients to develop new patterns of behavior
and develop new emotional skills through exposure and repetition in the
areas of:

Relaxation

Sensate Focus

Introspection and Communication

Interpersonal Relationship

Trust, Risk, Conflict Resolution, Intimacy, Closure

Exercises for Resolving Specific Sexual Dysfunction

Mutuality, Pleasure and Passion

Ending Relationships

Modeling

Whether intended or not, because they are seen as experts by the client,
Therapist and Surrogate are always modeling a value system. In
effective surrogate partner therapy, this is a conscious part of the
treatment, an integrated aspect of the therapeutic context which
therapist and surrogate manage on behalf of the clients' learning. The
client learns from what he sees and experiences with the therapist and
surrogate partner, as well as from what they suggest and assign.

Transformation

The unique relationship between surrogate and client can be an arena of
profound healing and transformation. As the relationship moves from the
first hello to the final farewell it develops client emotional maturity,
heals the insidious effects of severe trauma, and repairs the client's
damaged relationship with sexuality and sense of self-worth. Although
the relationship is relatively temporary, the experiences of genuine,
loving, intimacy and authenticity remain forever as touchstones in the
clients' inner world.

Overview of Surrogate Partner Therapy

Surrogate Partners engage with clients in emotionally and physically
intimate experiences that are simultaneously diagnostic, skill building
and transformational.

Media Projects

Each member of IPSA, when acting as a surrogate, shall adhere to the
following ethical standards:

The designation "surrogate partner" shall apply only in a
therapeutic situation comprised of client, surrogate, and supervising
therapist. A surrogate partner may be designated to act primarily as
either a substitute partner or a co-therapist depending upon the
agreement between the surrogate and the therapist.

The surrogate is responsible for fostering effective communication
with the supervising therapist and the client.

The surrogate's primary responsibility is to the therapeutic
situation of which she [note: the feminine pronoun is used here to
refer to the surrogate, and the masculine pronoun to refer to the
client, although both surrogate and client may be of either gender],
the client, and the supervising therapist(s) are integral parts. Within
this situation, the chief focus and primary ethical responsibility is
for the client's welfare.

The objectives and parameters of the therapeutic relationship shall
be discussed with the client by the supervising therapist and the
surrogate so that the client may make informed decisions.

The surrogate's relationship with the client is temporary, always
within the context of the therapeutic situation, and with the
supervision of the therapist.

The surrogate shall recognize the boundaries and limitations of her
competence. She will not attempt to use methods outside the range of her
training and experience. Should she think that the client may benefit
from such methods, she will communicate this to the supervising
therapist.

If a surrogate has a professional degree, certificate, license, or
accreditation which applies to other than surrogate work, the function
of "surrogate partner" shall be primary while she is working as a
surrogate. However, if there is agreement between the surrogate and the
supervising therapist that other methods and techniques, within her
competence, are appropriate for the welfare of the client, the surrogate
may use these additional skills.

If a supervising therapist is not available and a situation arises
which would normally require consultation with the therapist, the
surrogate is responsible for taking appropriate action for the welfare
of the client.

The surrogate's responsibility for the welfare of the client
continues until it is terminated by mutual agreement among client,
surrogate, and the therapist, or the client voluntarily terminates the
therapy.

The identity of a client, and all information received from or about
him in the therapeutic situation, shall not be communicated outside the
therapeutic triangle without the client's expressed permission. The
following are exceptions:

when there is a clear and imminent danger to individuals or society,
and then only to appropriate professional colleagues or public
authorities;

for the purposes of professional consultation with appropriate
colleagues;

for presentation of information to professional or lay groups, but
always with identities of individuals disguised.

Surrogates shall be responsible for adequate precautionary measures
against the transmission of communicable diseases and infections. It is
the surrogate's responsibility to determine that the client has taken
similar precautions.

It is the surrogate's responsibility to ensure protection against
conception.

Surrogates shall recognize that effectiveness in the therapeutic
situation depends, in part, upon the surrogate maintaining independent,
personally fulfilling social and sexual relationships.

In order to maintain optimum professionalism, surrogates are
responsible for:

obtaining relevant continuing education,

seeking prompt and effective help when personal problems arise,

receiving adequate supervision for cases.

Each member of IPSA who imparts information either publicly or
privately about surrogate work or the organization shall indicate
clearly whether the statements represent official IPSA policy or are
personal opinions.

Members shall be aware that they may be regarded as representative
of all surrogates or of IPSA members even at times when they are not
acting in these capacities. Therefore, their personal conduct should be
such as to uphold the professional reputation of surrogates and of
IPSA.

Announcements of surrogate services to the therapeutic community
shall be limited to a simple statement of name, training, credentials
and experience, address, phone number, a brief statement of methods used
and times available. Current and former supervising therapists shall be
identified only with their explicit permission.